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Cancer: The Emperor of All Maladies Chat

Welcome to Medscape's Live Chat on the Ken Burns' documentary Cancer: The Emperor of All Maladies, which was open for comment while the documentary aired on PBS March 30-April 1.

In this forum, readers were invited to respond to the documentary and the issues it raised about the future of cancer care. The live chat featured comments from Medscape’s expert contributors as well as links to information on the history of cancer research and the making of the film.

The first episode did a good job of highlighting the outsize role of pediatric oncology clinical research in launching the cancer research enterprise for adult patients. The suffering of a child has a unique impact on parents and family, and a willingness to engage in unproven therapies in the hope of a cure. I'm glad the film reminded us of the contributions of these children and their families to advancing cancer research and the development of new therapies. It's not lost on me that while our market-driven drug development system has yielded many new therapies for adult cancers, pediatric oncology is too small a "market" to attract much attention from drug developers. Given that so many children gave their lives in the pursuit of scientific advances that affect ALL cancer patients, do we owe them a renewed investment in finding new therapies for childhood cancers?

It is quite clear we have much to do to improve outcomes for patients with cancer. However, as this series also strongly states we have come a very long way over the past several decades in improving both the survival and quality-of-life for patients with cancer.

Last night I was clicking through the previews for Cancer: The Emperor of All Maladies on the PBS Apple TV channel, and came across the clip of Ken Burns talking about his mother's cancer. He tells of how he never knew a time when she wasn't seriously ill, and how she'd died when he was eleven years old. Those experiences were, in large part, what drove him to produce this series.

To a degree, I can relate. My dad's first cancer was diagnosed when he was in his forties, and I was four. That one was cured with surgery and radioactive iodine. He developed another when I was in high school, cured with surgery, then a third when I was in college. That one was incurable and despite resections and radiation and chemotherapy, it's the one that took him from us. This was over fifteen years ago, and still it's rare that a day goes by when I don't have a thought about it.

I'm surrounded by reminders, because now I'm training to be a hematologist/oncologist. The disease responsible for my first experiences with tragedy has been all around me for the last three years. I've spent hundreds of hours learning the details of treatment guidelines, trial data, and chemotherapy regimens, and the whole time the memories of watching it all from the other side of the desk have floated just below the surface.

The first two hours of the series are masterful storytelling. Watching the history of cancer research unfold, braided with the stories of the two young patients with leukemia, tugged me across the range of emotions. The narrator articulates this tension better than I can when describing the early days of leukemia therapy: "[Sidney] Farber's certainty that a cure would be found helped keep despair at bay. The Jimmy Fund Clinic, one visitor wrote, seemed suspended between two poles, both wonderful and tragic. Unspeakably depressing and indescribably hopeful."

You can imagine that my experience of learning to treat cancer has traversed a similar emotional landscape. Through medical school and residency, and now through fellowship, there were times when I was afraid the sadness would be too painful a reminder. There were also days I couldn't fathom doing anything or being anywhere else, because the rewards of working with cancer patients and their families are immeasurable. As treatments improve and new agents are discovered, we are changing the character of cancer itself.

Ken Burns describes why he moved forward with this video project. The void that his mother's illness left in his life is a driving force for him. His words: "As much as you want to move away from it, you have to move toward it." That sums it up perfectly.

I agree with Dr. Mukherjee that identifying a cure for cancer is one of the greatest challenges we face in human history. We as the cancer-treating community are where we are today because our predecessors and a group of brave patients chose to move toward this challenge over the last century. Rather than try to avoid the unspeakable depression that cancer threatens to impose, they chose to envision the indescribable hope for a cure.

This is the hope that we all hold, and someday we will find this hope realized.

Excited to see the remarkable story of cancer research and its impact on cancer care and health presented in episode two of "Emperor of All Maladies." Public recognition of the brilliance and hard work of so many dedicated researchers and clinicians is long overdue.

John Marshall was right - the waves of emotion are tough tonight. As a breast cancer specialist its hard to watch tonight's episode without a revolving slide show of current and former patients running through my head.

The opening of today's episode encapsulated all the reasons I became an oncologist - fascinating biology that seemed to hold the keys to life and immortality, amazing patients who are willing to share their lives with us in such a deep way.

The historical footing reminds us all what a white male world it was. Imagine how much farther we might have come if all had been welcome to contribute. It deepens my appreciation for early ASCO pioneer Jane Wright

The first segment of the three part series evokes intense emotions in viewers. It helps to juxtapose the historical challenges with the modern therapies, successful and sometimes not, with compassion and sensitivity. Personally, it is wonderful to see my past colleagues whom I knew personally and who contributed to my career in its early stages, and who bequeathed a generation of fine laboratory, translational and clinical scientists whose work and achievements are today curing so many patients. Kudos to the producers for part 1.

Farber's choice of aminopterin was due to hi observation that leukemia patients given folic acid seemed to die more rapidly. So he decided to use and anti-folic acid and aminopterin (and later methotrexate) were used in his trials.

As a practitioner of Hematolgy and Hematologic Oncology for over 40 years, I'm very impressed how accurately my experiences have been capture in this series. I question the statement that malignant cells dividemire rapidly than their normal counterparts. My recollection is that about 1960, studies using tritiated thymidine markers demonstrated that leukemia blasts divided less rapidly than normal

Just finishing a tough day in clinic....ended with learning that one of my patients with metastatic disease just had her medicaid cancelled. The reason - her husband who is also being treated for metastatic disease was granted disability so their income was too high. They missed deadine for signing up for HIP because he was in ICU. Will the last installment dare discuss the problem of spiralling costs and the number of our patiens who are bankrupt?

We should make common cause - within our field, with our patients, and with the public - to turn what was once a trickle of discoveries and is now a steady stream of monumental advances into a flood of progress. Having the story told, and told well, is an important achievement and an important step in that direction.

Patients like Gomez are the true heroes of oncology. Taking that fight to the unknown and incurring the risks associated with a new or experimental therapy, where the benefit may not even be for you but rather for those who follow you, takes incredible courage.

How do we maintain momentum for investments in new therapies, when many of these promised "miracle drugs" fail to deliver, or only briefly extend life, but leave patients and families with enormous financial burdens?